A study of postsurgery outcomes revealed that readmissions decreased among a Medicare population in the 2008 to 2016 period, but declines were not as much as expected.1
The Centers for Medicare & Medicaid Services (CMS) started a Hospital Readmissions Reduction Program in 2010. It includes penalties for excess readmissions for patients with certain medical diagnoses. Investigators used Medicare claims data from more than 2.4 million patients between 2008 and 2016. They found that risk-adjusted readmission rates declined before the program was announced and also declined (but not as much as expected) after the penalties were announced.1
“When CMS started the program in 2010, it applied to only three medical conditions. Over the years, it has applied to more,” observes Karan Chhabra, MD, MSc, national clinical scholar, Institute for Healthcare Policy & Innovation at the University of Michigan. “We have data to see whether adding penalties for surgical readmissions led to any additional decrease in medical readmissions.”
Readmission rates for hip replacement declined from 8.2% to 5.9%. Knee replacement surgery readmission rates declined from 7.3% to 5.3%. Episode payments also declined by more than $3,000 for each of those surgeries. When the readmission rate was compared according to a time period, with a time right after the penalties announcement counting as one time period, there was not an additional effect on readmissions, Chhabra says.
“While the actual readmissions rate did go down, the rate of improvements slowed down,” he adds. “We did see a continued downward trend, but the rate of that trend was the same as the rate before the Affordable Care Act was announced. They continued to improve, but more slowly.”
One possible reason that a stronger decline in readmissions was not evident is that hospitals might have anticipated the penalty for surgical cases and made improvements before it was officially announced, Chhabra offers. “There is a limit to how much we can reduce readmissions,” he adds. “Some patients might just need to go back into the hospital.”
- Chhabra KR, Ibrahim AM, Thumma JR, et al. Impact of Medicare readmissions penalties on targeted surgical conditions. Health Aff (Millwood) 2019;38:1207-1215.